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Renal system
Published in Pankaj Desai, Pre-eclampsia, 2020
It has been postulated that angiotensin-II may play an essential role in the pathogenesis of pre-eclampsia. In a transgenic mouse model, the mice developed pregnancy-associated hypertension (PAH) by the overproduction of angiotensin-II in maternal circulation during late pregnancy. The Mice with PAH exhibited maternal and foetal abnormalities, such as proteinuria, cardiac hypertrophy, placental morphological changes and IUGR. In one study, to attenuate the activity of redundant renin-angiotensin system during the advanced stages of PAH, olmesartan an angiotensin receptor blocker, was administered, as was captopril, an angiotensin-converting enzyme inhibitor, from 17 to 19 days of gestation, and evaluated for their effects on cardiac and placental abnormalities and foetal growth. Olmesartan and captopril administration lowered the blood pressure of mice with PAH, and placental histological change and severe IUGR were markedly ameliorated in both groups. On the contrary, both treatments had little effect on cardiac remodelling during the advanced stages of PAH. These findings highlight a variety of therapeutic actions of the renin-angiotensin system repression on the progressive pathology of PAH in mice.22
Cardiovascular Drugs
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: Olmesartan is contraindicated during the 2nd and 3rd Trimesters because the pregnancy experience in humans showed a profound potentiality of teratogenicity and severe fetal toxicity associated with its use during this period.
Mathematical simulation of the structure of pulsed arterial pressure relations with vascular damage factors in patients with arterial hypertension
Published in Waldemar Wójcik, Sergii Pavlov, Maksat Kalimoldayev, Information Technology in Medical Diagnostics II, 2019
O.V. Vysotska, Y.G. Bespalov, A.I. Pecherska, S.M. Koval, O.M. Lytvynova, A.M. Dyvak, M. Maciejewski, A. Kalizhanova
The patients were examined in the dynamics of combined antihypertensive and hypolipidemic therapy before treatment and 1 year after it. A combination of an angiotensin II receptor antagonist, Olmesartan in a daily dose of 20–40 mg and third generation calcium antagonist of prolonged action Lercanidipine in a daily dose of 10–20 mg with addition (if the target arterial pressure levels (AP) less than 140 and 90 mmHg were not reached) of the third drug – a highly selective beta-adrenoblocker with vasodilating activity Nebivolol in a daily dose of 5 mg, was used as antihypertensive therapy. Hypolipidemic therapy was performed with Atorvastatin at a daily dose of 20 mg. Drug therapy was administered against a background of recommendations on hypocaloric diet with restriction of easily digestible carbohydrates, as well as saturated fats and purines.
Ingestion-time differences in the pharmacodynamics of dual-combination hypertension therapies: Systematic review and meta-analysis of published human trials
Published in Chronobiology International, 2022
Ramón G. Hermida-Ayala, Artemio Mojón, José R. Fernández, Michael H. Smolensky, Ramón C. Hermida
Hoshino et al. (2010) compared the BP-lowering effect of bedtime vs. morning olmesartan/amlodipine (ARB/CCB) dual-combination therapy in an open-label, randomized, crossover trial, which also lacked a required washout period between the two tested treatment times, involving a small sample of 31 hypertensive patients (12 men/19 women, 69 ± 11 years of age). The dose of each individual medication was titrated on a per-patient basis, thereby ranging from 2.5 to 10 mg for amlodipine and 20 to 40 mg for olmesartan. The bedtime, relative to morning-time, treatment more effectively reduced the morning BP surge (24.2 ± 13.5 mmHg vs. 32.3 ± 14.2 mmHg, P < .001), nighttime BP in non-dipper (but not dipper) patients, and urinary albumin/creatinine ratio (42.5 ± 59.9 mg/g vs. 75.3 ± 26.4 mg/g; P = .044), thus inferring the bedtime, in comparison to morning-time, scheduling of this combination therapy exerts significantly better kidney protection. Furthermore, bedtime ingestion of the dual combination therapy was safe; no case of sleep-time hypotension was reported in either the dipper or non-dipper patients. The authors concluded bedtime treatment with the olmesartan/amlodipine dual-combination to be more appropriate than morning-time treatment to obtain the therapeutic goals of reduced sleep-time BP and improved kidney function.
Assessment of a strategy combining ambulatory blood pressure, adherence monitoring and a standardised triple therapy in resistant hypertension
Published in Blood Pressure, 2021
Erietta Polychronopoulou, Michel Burnier, Georg Ehret, Renate Schoenenberger-Berzins, Maxime Berney, Belen Ponte, Paul Erne, Murielle Bochud, Antoinette Pechère-Bertschi, Gregoire Wuerzner
After inclusion, all patients received a once a day single pill combination of olmesartan 40 mg and amlodipine 10 mg together with 25 mg chlorthalidone for 3 months. Medications were provided in two separated electronic pill boxes Medical Event Monitoring System, MEMS, AARDEX, Ltd, Zug, Switzerland). No washout period was included in the protocol. As blood pressure endpoints were measured after 3 months, a carryover effect of antihypertensive drugs prescribed before the standardised treatment seemed extremely unlikely. The protocol of the management algorithm is shown in Supplemental Figure 1. The EPB records the date and time of each opening of the pillbox as described previously [15]. The follow up included visits at 6 and 12 weeks. At 3 months, we analysed the EPB data to assess the dosing history and a second ABPM was performed to evaluate the out-of-office BP control. ABPM devices were programmed to take BP every 20 min during the day and 30 min during the night. BP cuff was adapted to arm circumferences. Day and night BP was defined according to sleep and wake-up time reported by patients in their diary. ABPM was considered of satisfactory quality if at least 20 measures were available during the day and at least 7 measures during the night [16].
Low-dose Bevacizumab Decreases Ocular Hypotensive Effect of Angiotensin II in Sprague Dawley Rats
Published in Current Eye Research, 2021
J. Skrzypecki, K. Ciepiaszuk, M. Gawryś-Kopczyńska
In contrast to our findings, some researchers postulate that inhibition of angiotensin II receptors, rather than stimulation, lowers IOP. However, studies involving angiotensin II receptor blockers (ARBs) are inconclusive,15,26-28 and industry-sponsored clinical trial investigating topical olmesartan was terminated due to insufficient IOP-lowering effect.29 Nevertheless, it is possible that intake of ARBs has IOP-lowering effect due to decreased production of the aqueous humor in selected patients.12 Notably, these observations are in line with hypothesis that angiotensin II could increase IOP by stimulation of aqueous humor production12 and decrease IOP due to vasoconstriction and reduction of blood supply to the ciliary body.11 Our data does not show any effect of low-dose bevacizumab on BP in rats. These results are in line with majority of clinical studies dealing with low-dose intravitreal injection of bevacizumab. Although both animal and human studies have shown that systemic high-dose anti-VEGF agents have an impact on endothelium, decrease nitric oxide production and lead to hypertension,30 majority of clinical trials on low-dose intravitreal anti-VEGF therapy did not find any interference with BP in a long-term observation.31–33